This is a case study of a Georgia based Gastroenterology (GI) clinic with two providers that processes over 500 claims per month. This clinic is only one of many installations from this Gastroenterology EMR partner, who submitted over 150K claims last year and recovered over $27M from hundreds of payers. This GI clinic looked for a secure cloud-based medical billing software to migrate from legacy software and chose expEDIum Medical Billing. On an average, a GI provider makes over $155K per year. Last year in expEDIum, this GI clinic had submitted claims with a value of about $3.9M and recovered over $591K from several payers resulting in an average of $295K per provider.
Issues faced earlier by the GI Clinic: -
- Late payment because of error claims getting submitted to the clearinghouse.
- The Payer paid their dues, but they were not posted into the system or posted manually.
- Several pending secondary claims were overlooked.
- They wanted to remove the paper superbill as it is an extra effort for the clinics.
- Looked for a solution that supported both Outpatient/Consulting and Ambulatory claims.
iTech migrated this client from their legacy system to eMB. iTech's eMB addressed the main issues faced by the biller effectively.
- The solution has a built-in claim validation and a claim scrubber that ensure only error-free claims are sent to the clearinghouse and the payers.
- The solution can auto reconcile and post the ERA received from Payer.
- eMB can identify pending secondary claims after auto-posting, auto-creates Payer-to-Payer COB secondary claims, and auto reconcile secondary payments. Hence, it does not leave any secondary claims un-billed, and secondary claim visibility is increased.
- This solution also has ESB (Electronic Super Bill) where it can capture all the charges and creating an electronic claim out of it. The biller increased the productivity and streamlined the billing operation with more automation and lesser paper handling with respect to bookkeeping, invoices, reports, patient statements, etc.
- expEDIum supports both CMS-1500 and UB04 claims seamlessly. This clinic has submitted over 900 ambulatory claims (UB04) alongside thousands of professional claims (CMS-1500) in the last year.
The providers were able to access their data using secure operator logons, and the clinic administrator had a variety of reports available to her at any time. This installation used Office Ally® as their chosen clearinghouse as their payer list had good coverage of relevant payers. They had also enrolled with all the relevant payers to receive ERAs automatically through the clearinghouse.
Return on Investment (ROI)
- The clinic processes over 500 claims a month with less than 1% denial rate.
- The overall productivity improved, resulting in better claim visibility and denial/rejections processing.
- The secondary collection went up from 4% (of total charges) to 5% due to increased visibility resulting in an additional $18,000 collection per year since they started using our solution.
- The clinic uses ESB instead of paper superbill, saving almost a person month of data entry time per year.
- Instead of going to other Payer or Clearinghouse portals and making eligibility inquiry they used expEDIum's seamless IEV and saved almost a half-person month of data entry and convenience time per year.
As you can see from the above data, the clinic saves over 2.5 person months of data entry per year and makes an additional $18,000 from secondary collection per year. If we assume that a biller's wage is $19/hr, we can see that the clinic saves over $8,300 per year. The clinic is only paying $3240 per year for the software subscription, thus saving them over $23K per year. Currently, iTech is working on cross-over of primary HCFA to secondary UB04 and vice versa and claim cloning from one to another, which will save them additional labor.